Nocardia asteroides osteomyelitis has previously been described only in acutely ill patients. It may occur as an isolated event or part of the disease spectrum of disseminated nocardiosis. An 84 year old immune competent man with N. asteroides right tibial osteomyelitis had an unusual presentation, presumed mechanism of disease and outcome. His course affords an opportunity to review the literature on N. asteroides osteomyelitis and to discuss the unique features of his case.